UMEM Educational Pearls

Title: Pediatric poisoning trends

Keywords: Pediatric poisoning, household , fatalities (PubMed Search)

Posted: 3/30/2017 by Kathy Prybys, MD
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Children less than 5 years of age account for the majority of poisoning exposures in the United States. As expected, accessible household items are the most frequently reported exposures and include cosmetics and personal care products, household cleaning substances, medications, and foreign bodies. Opioids are responsible for the highest incidence of hospitalizations followed by benzodiazepines, sulfonylureas, and cardiovascular drugs (beta & calcium channel blockers, and centrally acting antiadrenergic agents). Rise in buprenorphine use has led to significant increases in pediatric exposures. The most common sources of prescription medications were pills found on the ground, in a purse or bag, night stand, or pillbox. The 2015 American Association of Poison Centers Annual report lists 28 fatalities in children less than 5 year of age. Fatalities occurred from exposures to the following: narcotics (9), disc and button batteries (5), carbon monoxide (4), and other substances (10).

Highlighted AAPC cases include:

20 month old with ingestion of 20 mm Lithuim disc battery with several previous ED visits for abdominal pain who developed an aorto-esophageal fistula
13 month old with ingestion of unknown amount of salicylate pills 4 hours earlier with nausea and vomiting
2 year old with ingestion of 5 tablets of 30mg Oxycodone ER seen in ED and discharged 7 hours later. EMS called next morning found patient unresponsive and apneic
11 month old with ingestion of 1 unknown strength methadone pill found unresponsive and apneic at home

Poison prevention education of patients prescribed opioids or other highly toxic "one pill killers" who have young children in their household is recommended and could be potentially life saving.

References

2015 Annual Report of the American Association of Poison Centers' National Poison Data System: 33rd Annual Report. Mowrey JB, et al. Clinical Toxicology, 54:10.924-1109.

Emergency Hospitalizations for Unsupervised Prescription Medication Ingestions by Young Children, Lovegrove MC, et al. Pediatrics. 2014,134 (4) e1009-e1016 .

The Underrecognized Toll of Prescription Opioid Abuse on Young Children. Bailey JE, et al. Ann of Emerg Med. April 2009:53(4): 419-24. doi:10.1016/j.annemergmed.2008.07.015.Epub 2008 Sep 6.